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MARION COUNTY BUILDING INSPECTION <br /> <br /> ,'~/ ~/~ /)Y/ FOR OFFICE USE ONLY] <br />FOR:OFFIC~ USE OiNLY [ 220 High Street NE <br />Received by:/~-.~ ~ ~ S~m, OR 97301 <br />Zomng hlidatio~ I 8:~ am-4:g~m ~o~ 588-5147 <br />Date'. g ~/~E ~'~ ] ~-A-~oneF~ 58S-39a*588'7904 L~t S~e'. <br /> <br /> COMPS'rE ALL S~C~O~5. I TI.ffiOUO, 4 PER~T APPLICAT~I~ <br /> 1. Job D~chI ~n . <br /> <br />Location of Installation ~ &,/. ~ ~r~..l]r-.e, <br /> <br />3. Conwactor Information <br /> <br />( ) I undenmnd ~at I mast ~smr as a cmstm~ c~cmr ~ ~e s~m is sold of offered for sale b~om or u~n comple~om <br /> <br />( ) I wffi be my o~ gmerM oontmgon <br /> <br />If I hk¢ subcontractors, ! will him only subcontractors registered with the Construction Contractors Boa~l. <br /> <br />I/I change my mind and do hire a general conmctor, I will contrae£ with a ¢,:mtraetor who is reg/stemd with the Constractlon Contraet0fs Board, and will <br />immediately notify Marion County of the name of the COntractor. <br /> <br />4. Fee Schedule <br /> <br />A. (i) Manufaeturedliom¢ <br /> or Modular Unit PlacemenffConn¢ciion <br /> <br /> (2) State Fee <br /> (3,) ~tat¢ Sure, barge ~ /.~.t-.- <br /> (4) Zoning Surcharge 05.00 ff applieabl¢) <br /> <br />B. (1) Mfg.'dStmemreStorageFe~ <br /> @ <br />(~) Mfg.'d Stmcm~ Storage R~ewal @ 25.00 = <br />(3) Zoning Surcharge (15.00 if applicable) @ 15,00 = <br /> <br />B. Other [nspe¢lions not listed <br /> @ 40.00 per hour (2 hour mirdmum) <br /> <br />(¢ $60.00 =_~ <br /> <br />@ $40.00 <br /> <br />TOTAL= <br /> <br />service or plumbing water/Sewer lines a re s¢lharate requlred permits. MC 15-64 Rev 11-91 <br /> <br /> <br />